Sisnowski Jana, Street Jackie M, Merlin Tracy
School of Public Health, University of Adelaide, Adelaide, South Australia, Australia.
Adelaide Health Technology Assessment (AHTA), School of Public Health, University of Adelaide, Adelaide, South Australia, Australia.
PLoS One. 2017 Aug 4;12(8):e0182581. doi: 10.1371/journal.pone.0182581. eCollection 2017.
This systematic review (PROSPERO: CRD42015025276) employs a realist approach to investigate the effect of "real-world" policies targeting different aspects of the food environment that shape individual and collective nutrition.
We were interested in assessing intermediate outcomes along the assumed causal pathway to "policy success", in addition to the final outcome of changed consumption patterns.
We performed a search of 16 databases through October 2015, with no initial restriction by language.
We included all publications that reported the effect of statutory provisions aimed at reducing the consumption of energy-dense foods and beverages in the general population. We allowed all methodological approaches that contained some measure of comparison, including studies of implementation progress.
We reviewed included studies using the appraisal tools for pre-post and observational studies developed by the National Heart, Lung, and Blood Institute. Given the considerable heterogeneity in interventions assessed, study designs employed, and outcome measures reported, we opted for a narrative synthesis of results.
Results drawn from 36 peer-reviewed articles and grey literature reports demonstrated that isolated regulatory interventions can improve intermediate outcomes, but fail to affect consumption at clinically significant levels. The included literature covered six different types of interventions, with 19 studies reporting on calorie posting on chain restaurant menus. The large majority of the identified interventions were conducted in the US. Early results from recent taxation measures were published after the review cut-off date but these suggested more favorable effects on consumption levels. Nevertheless, the evidence assessed in this review suggests that current policies are generally falling short of anticipated health impacts.
本系统评价（国际前瞻性系统评价注册库编号：CRD42015025276）采用现实主义方法，研究针对塑造个人和集体营养的食品环境不同方面的“现实世界”政策的效果。
除了改变消费模式的最终结果外，我们还对评估沿着假定的通向“政策成功”的因果路径的中间结果感兴趣。
截至2015年10月，我们对16个数据库进行了检索，最初没有语言限制。
我们纳入了所有报告旨在减少普通人群中能量密集型食品和饮料消费的法定条款效果的出版物。我们允许所有包含某种比较措施的方法学途径，包括实施进展研究。
我们使用美国国立心肺血液研究所开发的前后对照研究和观察性研究评估工具对纳入的研究进行了审查。鉴于所评估的干预措施、所采用的研究设计和所报告的结果测量存在相当大的异质性，我们选择对结果进行叙述性综合。
从36篇同行评审文章和灰色文献报告中得出的结果表明，孤立的监管干预措施可以改善中间结果，但未能在临床上显著影响消费。纳入的文献涵盖了六种不同类型的干预措施，其中19项研究报告了连锁餐厅菜单上的卡路里标注情况。大多数已确定的干预措施在美国进行。近期税收措施的早期结果在审查截止日期之后发表，但这些结果表明对消费水平有更有利的影响。尽管如此，本综述评估的证据表明，当前政策总体上未达到预期的健康影响。
